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CMAJ : Canadian Medical Association... Apr 2022
Topics: Brachial Plexus Neuritis; Humans; Physiatrists
PubMed: 35379665
DOI: 10.1503/cmaj.220382 -
Cancers May 2018Progress in cancer treatment has improved the survival of patients with advanced-stage cancers. Consequently, the clinical courses of patients are prolonged and often... (Review)
Review
Progress in cancer treatment has improved the survival of patients with advanced-stage cancers. Consequently, the clinical courses of patients are prolonged and often accompanied by morbidity due to bone metastases. Skeletal-related events (SREs), such as pathological fractures and spinal paralysis, cause impairment in activities of daily life and quality of life (QOL). To avoid serious SREs causing impairment in QOL and survival, early diagnosis and a prophylactic approach are required. It is necessary to initiate a bone management program concurrently with the initiation of cancer treatment to prevent complications of bone metastasis. In addition, the requirement of a multidisciplinary approach through a cancer board focusing on the management of bone metastases and involving a team of specialists in oncology, palliative care, radiotherapy, orthopedics, nuclear medicine, radiology, and physiatrists has been emphasized. In the cancer board, a strong focus is placed on the prevention of complications due to bone metastases and on reductions in the high morbidity, hospitalization rate, and overall costs associated with advanced-stage cancers. Recent reports suggest the usefulness of such approaches. The multidisciplinary approach through a cancer board would improve QOL and prognosis of patients, leading to new or continued systemic therapy for primary cancers.
PubMed: 29795015
DOI: 10.3390/cancers10060156 -
Archives of Rheumatology Dec 2021This study aims to identify the relationship between treatment modalities and the patients' preferences in osteoarthritis (OA) treatment and identify the related factors.
OBJECTIVES
This study aims to identify the relationship between treatment modalities and the patients' preferences in osteoarthritis (OA) treatment and identify the related factors.
PATIENTS AND METHODS
This multi-center, cross-sectional study included a total of 305 patients with OA (66 males, 239 females; mean age: 66.4±9.7 years; range, 38 to 90 years) between July 2019 and January 2020. Data including demographic and clinical characteristics of the patients were recorded using a structured questionnaire.
RESULTS
The mostly common involvement sites were knee joints, lumbar, and cervical regions, respectively. Prior to the study, the treatment modalities which were prescribed to patients were oral drugs (79.7%), topical drugs (73.8%), home-based exercise program (62.6%), and physical therapy (outpatient) (61.3%). Of the recommended remedy, 89.2% were prescribed by physiatrists, 24.6% by orthopedists, 5.6% by family practitioners, 2.6% by neurosurgeons, and 1.6% by algologists. The most beneficial treatments (to whom) were inpatient physical therapy program (47%), oral drugs (41%), home-based exercise programs (24.9%) according to patients' perspective. According to patient preferences, nearly half of the patients preferred outpatient physical therapy program (45.9%), oral drugs (33.1%), inpatient physical therapy (20%), and home-based exercises (18%). The most common reasons for their preferences were previous benefits from treatment (54.4%), long-term effects (38%), easy access to treatment (33.1%) and concerns about side effects (28.9%). The mostly common reasons for their preferences were previous benefits from the treatment (54.4%), long-term positive effects of physical therapy (38%), easy access to the treatment (33.1%) and concerns about side effects of drugs (28.9%).
CONCLUSION
Besides medical regimen, the results of this study showed that the patients preferred outpatient and inpatient physical therapy modalities, and home-based exercises programs. In the light of these findings, initiation of a new prescription (e.g., drugs or physical therapy modalities) in OA patients, previous treatment modalities, and approaches are suggested to be carefully reviewed by the clinician to anticipate and improve the adherence behavior to the new treatment.
PubMed: 35382376
DOI: 10.46497/ArchRheumatol.2022.8291 -
Pain Reports 2021Chronic pelvic pain (CPP) is a highly prevalent condition which is underdiagnosed and poorly understood. The purpose of this review is to outline the various aspects of... (Review)
Review
Chronic pelvic pain (CPP) is a highly prevalent condition which is underdiagnosed and poorly understood. The purpose of this review is to outline the various aspects of the nature of CPP, including its etiologies, clinical presentation, and nonoperative treatment options. For data collection, a PubMed search was conducted using indexing terms such as chronic pelvic pain and pelvic pain. Literature reviews and studies focusing on etiologies, clinical presentation, and/or the diagnosis of CPP were compiled for review by a team of 3 physiatrists. Studies investigating conservative treatments, medications, and interventional procedures for CPP and related conditions with comparable etiologies were also included. Of the 502 articles retrieved, 116 were deemed suitable by the team for this study. Although CPP is a complex, multifaceted condition, a particular susceptibility to nociceptive stimuli was demonstrated as an underlying theme in its evolution. There are many treatment options currently used; however, more robust evidence, such as randomized controlled trials, are needed before creating comprehensive guidelines for treating CPP.
PubMed: 34476302
DOI: 10.1097/PR9.0000000000000949 -
EFORT Open Reviews Aug 2023The total number of spine surgeries is increasing, with a variable percentage of patients remaining symptomatic and functionally impaired after surgery. Rehabilitation... (Review)
Review
The total number of spine surgeries is increasing, with a variable percentage of patients remaining symptomatic and functionally impaired after surgery. Rehabilitation has been widely recommended, although its effects remain unclear due to lack of research on this matter. The aim of this comprehensive review is to resume the most recent evidence regarding postoperative rehabilitation after spine surgery and make recommendations. The effectiveness of cervical spine surgery on the outcomes is moderate to good, so most physiatrists and surgeons agree that patients benefit from a structured postoperative rehabilitation protocol and despite best timing to start rehabilitation is still unknown, most programs start 4-6 weeks after surgery. Lumbar disc surgery has shown success rates between 78% and 95% after 2 years of follow-up. Postoperative rehabilitation is widely recommended, although its absolute indication has not yet been proven. Patients should be educated to start their own postoperative rehabilitation immediately after surgery until they enroll on a rehabilitation program usually 4-6 weeks post-intervention. The rate of lumbar interbody fusion surgery is increasing, particularly in patients over 60 years, although studies report that 25-45% of patients remain symptomatic. Despite no standardized rehabilitation program has been defined, patients benefit from a cognitive-behavioral physical therapy starting immediately after surgery with psychological intervention, patient education and gradual mobilization. Formal spine rehabilitation should begin at 2-3 months postoperatively. Rehabilitation has benefits on the recovery of patients after spine surgery, but further investigation is needed to achieve a standardized rehabilitation approach.
PubMed: 37526242
DOI: 10.1530/EOR-23-0015 -
Injury Nov 2023Appropriate care and rehabilitation following surgery for fragility hip fractures in older adults is associated with better outcomes and a greater likelihood of... (Review)
Review
INTRODUCTION
Appropriate care and rehabilitation following surgery for fragility hip fractures in older adults is associated with better outcomes and a greater likelihood of achieving pre-injury functioning. Clinical guidelines specifically for the post-operative care and rehabilitation of patients with hip fractures are scarce; as such, country-specific protocols benchmarked against established guidelines are essential given the wide variation in cultures and beliefs, clinical practice and diverse healthcare systems in Asia. We aimed to provide clinically relevant recommendations for post-operative fragility hip fracture care and rehabilitation to improve patient outcomes and prevent subsequent fractures in Thailand.
METHODS
A targeted literature review was conducted to identify key evidence on various elements of post-hip fracture care and rehabilitation. Further discussions at a meeting and over email correspondence led to the development of the recommendations which amalgamate available evidence with the clinical experience of the multidisciplinary expert panel.
RESULTS
Our recommendations are categorized by one period domain - acute post-operative period, and five major domains during the post-operative period - rehabilitation, optimization of bone health, prevention of falls, nutritional supplementation, and prophylaxis for venous thromboembolism. A multidisciplinary approach should be central to the rehabilitation process with the involvement of orthopedists, geriatricians/internists, physiatrists, physical and occupational therapists, endocrinologists, pharmacists and nursing staff. Other key components of our recommendations which we believe contribute to better functional outcomes in older patients undergoing hip fracture surgery include comprehensive pre-operative assessments, early surgery, goal setting for recovery and rehabilitation, early mobilization, medication optimization, tailored exercise plans, adequate coverage with analgesia, assessment and appropriate management of osteoporosis with due consideration of the fracture risk, fall prevention plans, and nutritional assessment and support. Patients and their caregivers should be a part of the recovery process at every step, and they should be counseled and educated appropriately, particularly on the importance of adherence to their rehabilitation plan.
CONCLUSION
We have provided guidance on the critical domains of clinical care in the post-operative setting to optimize patient outcomes and prevent fracture recurrence. Our recommendations for post-operative care and rehabilitation of older adults with hip fracture can serve as a framework for hospitals across Thailand.
Topics: Humans; Aged; Thailand; Hip Fractures; Osteoporosis; Exercise
PubMed: 37757673
DOI: 10.1016/j.injury.2023.111039 -
The Cochrane Database of Systematic... Nov 2016Neck pain is one of the three most frequently reported complaints of the musculoskeletal system. Treatments for neck pain are varied, as are perceptions of benefit.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Neck pain is one of the three most frequently reported complaints of the musculoskeletal system. Treatments for neck pain are varied, as are perceptions of benefit. Acupuncture has been used as an alternative to more conventional treatment for musculoskeletal pain. This review summarises the most current scientific evidence on the effectiveness of acupuncture for acute, subacute and chronic neck pain. This update replaces our 2006 Cochrane review update on this topic.
OBJECTIVES
To determine the effects of acupuncture for adults with neck pain, with focus on pain relief, disability or functional measures, patient satisfaction and global perceived effect.
SEARCH METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, the Manual, Alternative and Natural Therapy Index System (MANTIS), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Index to Chiropractic Literature (ICL) from their beginning to August 2015. We searched reference lists, two trial registers and the acupuncture database Traditional Chinese Medical Literature Analysis and Retrieval System (TCMLARS) in China to 2005.
SELECTION CRITERIA
We included published trials that used random assignment to intervention groups, in full text or abstract form. We excluded quasi-randomised controlled trials (RCTs).
DATA COLLECTION AND ANALYSIS
Two review authors made independent decisions for each step of the review: article inclusion, data abstraction and assessment of quality of trial methods. We assessed study quality by using the Cochrane Back Review Group 'Risk of bias' tool. We used consensus to resolve disagreements, and when clinical heterogeneity was absent, we combined studies by using random-effects meta-analysis models.
MAIN RESULTS
Of the 27 included studies, three represented individuals with whiplash-associated disorders (WADs) ranging from acute to chronic (205 participants), five explored chronic myofascial neck pain (186 participants), five chronic pain due to arthritic changes (542 participants), six chronic non-specific neck pain (4011 participants), two neck pain with radicular signs (43 participants) and six subacute or chronic mechanical neck pain (5111 participants).For mechanical neck pain, we found that acupuncture is beneficial at immediate-term follow-up compared with sham acupuncture for pain intensity; at short-term follow-up compared with sham or inactive treatment for pain intensity; at short-term follow-up compared with sham treatment for disability; and at short-term follow-up compared with wait-list control for pain intensity and neck disability improvement. Statistical pooling was appropriate for acupuncture compared with sham for short-term outcomes due to statistical homogeneity (P value = 0.83; I = 20%). Results of the meta-analysis favoured acupuncture (standardised mean difference (SMD) -0.23, 95% confidence interval (CI) -0.20 to -0.07; P value = 0.0006). This effect does not seem sustainable over the long term. Whether subsequent repeated sessions would be successful was not examined by investigators in our primary studies.Acupuncture appears to be a safe treatment modality, as adverse effects are minor. Reported adverse effects include increased pain, bruising, fainting, worsening of symptoms, local swelling and dizziness. These studies reported no life-threatening adverse effects and found that acupuncture treatments were cost-effective.Since the time of our previous review, the quality of RCTs has improved, and we have assessed many of them as having low risk of bias. However, few large trials have provided high-quality evidence.
AUTHORS' CONCLUSIONS
Moderate-quality evidence suggests that acupuncture relieves pain better than sham acupuncture, as measured at completion of treatment and at short-term follow-up, and that those who received acupuncture report less pain and disability at short-term follow-up than those on a wait-list. Moderate-quality evidence also indicates that acupuncture is more effective than inactive treatment for relieving pain at short-term follow-up.
Topics: Acupuncture Therapy; Chronic Pain; Humans; Neck Pain; Pain Measurement; Randomized Controlled Trials as Topic; Treatment Outcome; Whiplash Injuries
PubMed: 27852100
DOI: 10.1002/14651858.CD004870.pub5 -
Acta Ortopedica Brasileira 2022The Brazilian Consensus on Hip Viscosupplementation aims to generate a referential and consensual source from the theoretical knowledge and clinical experience of... (Review)
Review
OBJECTIVE
The Brazilian Consensus on Hip Viscosupplementation aims to generate a referential and consensual source from the theoretical knowledge and clinical experience of specialists in the field.
METHODS
A multidisciplinary panel was formed with 15 specialists (sports medicine, orthopedists, physiatrists and rheumatologists), based on clinical and academic experience in the use of viscosupplementation of the hip. 12 statements were prepared, discussed and voted. Each panelist gave a value between 0 and 10 on a Likert scale, specifying their level of agreement with the statement.
RESULTS
The panel reached a consensus on several aspects of viscosupplementation of the hip, with emphasis on the following statements: best indication is for mild to moderate hip arthrosis; it may be indicated in severe osteoarthritis; results may vary according to the characteristics of the viscosupplement used; Viscosupplementation should not be performed as an isolated procedure, but in conjunction with other rehabilitation and pharmacological measures; best injection technique should be based on anatomical references coupled with imaging guidance; it is a cost-effective procedure.
CONCLUSION
Viscosupplementation is a safe and effective therapy for hip osteoarthritis, even in severe cases. Guided injection is recommended.
PubMed: 36451782
DOI: 10.1590/1413-785220223005e250414 -
BMC Medical Education Mar 2022The 36-month Physical Medicine and Rehabilitation (PM&R) or Physiatry residency provides a number of multidisciplinary clinical experiences. These experiences often...
BACKGROUND
The 36-month Physical Medicine and Rehabilitation (PM&R) or Physiatry residency provides a number of multidisciplinary clinical experiences. These experiences often translate to novel research questions, which may not be pursued by residents due to several factors, including limited research exposure and uncertainty of how to begin a project. Limited resident participation in clinical research negatively affects the growth of Physiatry as a field and medicine as a whole. The two largest Physiatry organizations - the Association of Academic Physiatrists and the American Academy of Physical Medicine and Rehabilitation - participate in the Disability and Rehabilitation Research Coalition (DRRC), seeking to improve the state of rehabilitation and disability research through funding opportunities by way of the National Institutes of Health (NIH), the National Institute on Disability, Independent Living and Rehabilitation Research (NIDILRR) and the Patient-Centered Outcomes Research Institute (PCORI). A paucity of new Physiatry researchers neutralizes these efforts.
RESULTS
This paper details the creation of a novel, multidisciplinary Rehabilitation Resident Research program that promotes resident research culture and production. Mirroring our collaborative clinical care paradigm, this program integrates faculty mentorship, institutional research collaborates (Neuroscience Nursing Research Center, Neuroscience Research Development Office) and departmental resources (Shark Tank competition) to provide resident-centric research support.
CONCLUSIONS
The resident-centric rehabilitation research team has formed a successful research program that was piloted from the resident perspective, facilitating academic productivity while respecting the clinical responsibilities of the 36-month PM&R residency. Resident research trainees are uniquely positioned to become future leaders of multidisciplinary and multispecialty collaborative teams, with a focus on patient function and health outcomes.
Topics: Efficiency; Humans; Internship and Residency; Physical and Rehabilitation Medicine; Rehabilitation Research; United States
PubMed: 35277154
DOI: 10.1186/s12909-022-03167-3 -
Aging Clinical and Experimental Research Apr 2023Dementia Day Care Centres (DDCCs) are defined as services providing care and rehabilitation to people with dementia associated with behavioural and psychological... (Review)
Review
Dementia Day Care Centres (DDCCs) are defined as services providing care and rehabilitation to people with dementia associated with behavioural and psychological symptoms (BPSD) in a semi-residential setting. According to available evidence, DDCCs may decrease BPSD, depressive symptoms and caregiver burden. The present position paper reports a consensus of Italian experts of different disciplines regarding DDCCs and includes recommendations about architectural features, requirements of personnel, psychosocial interventions, management of psychoactive drug treatment, prevention and care of geriatric syndromes, and support to family caregivers. DDCCs architectural features should follow specific criteria and address specific needs of people with dementia, supporting independence, safety, and comfort. Staffing should be adequate in size and competence and should be able to implement psychosocial interventions, especially focused on BPSD. Individualized care plan should include prevention and treatment of geriatric syndromes, a targeted vaccination plan for infectious diseases including COVID-19, and adjustment of psychotropic drug treatment, all in cooperation with the general practitioner. Informal caregivers should be involved in the focus of intervention, with the aim of reducing assistance burden and promoting the adaptation to the ever-changing relationship with the patient.
Topics: Humans; Aged; Dementia; Day Care, Medical; Syndrome; COVID-19; Caregivers
PubMed: 36795236
DOI: 10.1007/s40520-023-02356-4